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Research Paper|Volume 14, Issue 16|pp 6449—6466

Fecal microbiota transplantation can improve cognition in patients with cognitive decline and Clostridioides difficile infection

Soo-Hyun Park1, Jung-Hwan Lee2, Jun-Seob Kim3, Tae Jung Kim4, Jongbeom Shin5, Jae Hyoung Im6, Boram Cha5, Suhjoon Lee5, Kye Sook Kwon5, Yong Woon Shin5, Sang-Bae Ko4, Seong Hye Choi7
  • 1Department of Neurology, Department of Critical Care Medicine, Department of Hospital Medicine, Inha University Hospital, Incheon 22332, Republic of Korea
  • 2Division of Gastroenterology, Department of Internal Medicine, Department of Hospital Medicine, Inha University Hospital, Incheon 22332, Republic of Korea
  • 3Department of Nano-Bioengineering, Incheon National University, Incheon 22012, Republic of Korea
  • 4Department of Neurology and Department of Critical Care Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
  • 5Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Republic of Korea
  • 6Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Republic of Korea
  • 7Department of Neurology, Inha University School of Medicine, Incheon 22332, Republic of Korea
Received: February 17, 2022Accepted: August 4, 2022Published: August 16, 2022
https://doi.org/10.18632/aging.204230

Copyright: © 2022 Park et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

After fecal microbiota transplantation (FMT) to treat Clostridioides difficile infection (CDI), cognitive improvement is noticeable, suggesting an essential association between the gut microbiome and neural function. Although the gut microbiome has been associated with cognitive function, it remains to be elucidated whether fecal microbiota transplantation can improve cognition in patients with cognitive decline.

The study included 10 patients (age range, 63–90 years; female, 80%) with dementia and severe CDI who were receiving FMT. Also, 10 patients (age range, 62–91; female, 80%) with dementia and severe CDI who were not receiving FMT. They were evaluated using cognitive function tests (Mini-Mental State Examination [MMSE] and Clinical Dementia Rating scale Sum of Boxes [CDR-SB]) at 1 month before and after FMT or antibiotics treatment (control group). The patients’ fecal samples were analyzed to compare the composition of their gut microbiota before and 3 weeks after FMT or antibiotics treatment.

Ten patients receiving FMT showed significantly improvements in clinical symptoms and cognitive functions compared to control group. The MMSE and CDR-SB of FMT group were improved compare to antibiotics treatment (MMSE: 16.00, median, 13.00–18.00 [IQR] vs. 10.0, median, 9.8–15.3 [IQR]); CDR-SB: 5.50, median, 4.00–8.00 [IQR]) vs. 8.0, median, 7.9–12.5, [IQR]). FMT led to changes in the recipient’s gut microbiota composition, with enrichment of Proteobacteria and Bacteroidetes. Alanine, aspartate, and glutamate metabolism pathways were also significantly different after FMT.

This study revealed important interactions between the gut microbiome and cognitive function. Moreover, it suggested that FMT may effectively delay cognitive decline in patients with dementia.